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Are those really SARS-CoV-2 virions in the kidney?

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Several studies report direct infection of different types of kidney cells by SARS-CoV-2 detected by transmission electron microscopy (TEM) both on post-mortem analysis and kidney biopsy specimens. However, these studies did not include detection of viral RNA or other methods for viral detection of kidney specimens and thus it is unclear whether the observed particles are definitely coronavirions or other similar coated vesicles eg clarthrin coated vesicles, which are comparablein size and morphology. Frelih et al used RT-PCR to identify direct invasion of SARS-Co-V2 in conjunction with TEM analysis on fresh post-mortem lung and kidney specimens of COVID-19 patients.

Read the full article here: https://www.kireports.org/article/S2468-0249(20)31368-1/fulltext

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Is longer dialysis necessarily better? The results of the ACTIVE Trial

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A Clinical Trial of IntensiVE (ACTIVE) Dialysis randomized 200 participants to extended hours (≥24 hours/week) or standard (≤18 hours/week) dialysis for 12 months to determine whether extended hours result in improved survival. After completing the 12-month study period participants could change their dialysis regimen, but continued a pre-specified observational follow-up for a further 4 years. Overall, participants were followed for a combined 877.5 patient-years. There was no improvement of long-term survival noted; suggesting that the optimal “amount” of dialysis across a broad range of dialysis recipients is yet to be defined.

Read the article at https://onlinelibrary.wiley.com/doi/abs/10.1111/nep.13737

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Elbasvir and grazoprevir successfully eliminate HCV infection in HCV-naïve recipients of HCV-infected kidneys

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HCV infected persons represent a growing pool of organ donors because they are typically younger and have fewer comorbidities than average donors. The introduction of direct-acting antivirals (DAAs) which successfully achieve sustained virologic response in >95% of cases has opened the door to clinical trials investigating feasibility and safety of transplantations from HCV-infected donors to HCV-naïve recipients treated with DAAs. A study by Sise et al. reports on the effects of preemptive treatment with elbasvir and grazoprevir in eight HCV-naïve recipients of HCV-infected kidneys. All recipients achieved sustained virologic response twelve weeks after therapy with no severe adverse events. Seven of them had excellent allograft function at six months, and one experienced early graft loss due to venous thrombosis.

Read full text at https://www.sciencedirect.com/science/article/pii/S2468024920300085

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Cardiovascular risk of nonsteroidal anti-inflammatory drugs occurs independently of dose and duration of exposure in dialysis patients

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in dialysis patients, despite their well-established adverse effects. A case cross-over study was conducted by Joo et al. to assess the association of NSAIDs with major adverse cardiac and cerebrovascular events (MACCEs) and mortality in dialysis patients. The results showed that nonselective NSAIDs significantly increased the risk of MACCEs and mortality, whilst selective cyclooxygenase-2 inhibitors did not exhibit the same effect. The risk of MACCEs and mortality risk was not dose-dependent manner. Interestingly, the association of exposure to NSAIDs with the risk of mortality was attenuated in dialysis patients who were concomitantly prescribed β-blockers.

Read full text at https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfz276/5704438

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Dysregulated turnover of collagen type III is an important determinant of chronic kidney disease progression

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Collagen type III (COL3) is one of the most abundant extracellular matrix components in the human body; decreased urinary levels of a degradation fragment of COL3 (C3M) were associated with the severity of CKD in patients with immunoglobulin A nephropathy and kidney allograft failure. Genovese et al. assessed the relationship between fragments reflecting active formation (PRO-C3) and degradation (C3M) of COL3 and CKD disease progression and mortality in 500 patients from the Renal Impairment in Secondary Care study. In a paper recently published in Clinical Kidney Journal they concluded that products of COL3 formation and degradation were independently associated with CKD progression and mortality, thus representing an opportunity to link pathological processes with targeted treatments against fibrosis.

Read full text at https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfz174/5704451

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Elderly patients also benefit from kidney transplantation

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So far, kidney transplantation has generally not been offered to elderly patients (>75 years) because of the perioperative risks. Nor has it been clearly established whether transplanted patients in this age benefit significantly. In a new study published in NDT, the graft survival proved to be excellent, and nearly all patients remained dialysis-free. Is it time to rethink established common practice?

Read the press release. Click here

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Consensus statement from the American College of Radiology and the National Kidney Foundation on the use of intravenous iodinated contrast media in patients with kidney disease

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The true risk of contrast induced acute kidney injury is unknown. However, the presumed risk of administering modern intravenous iodinated contrast media in patients with reduced kidney function seems to be overstated. A recently disclosed consensus statement from the American College of Radiology and the National Kidney Foundation define the patients at high risk to develop CI-AKI as those with recent AKI and eGFR less than 30 mL/min/1.73 m2 for whom prophylaxis with intravenous normal saline is recommended. Prophylaxis is not indicated for patients with stable eGFR greater than or equal to 45 mL/min/1.73 m2 and renal replacement therapy should not be initiated or dialysis schedule adjusted solely due to contrast media administration.

Read the full document at: https://www.kidneymedicinejournal.org/article/S2590-0595(20)30002-9/fulltext

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Simultaneous pancreas-kidney (SPK) transplantation improves survival compared with kidney transplantation alone in patients with diabetes type 1

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Patients with type 1 diabetes and end-stage kidney disease experience inferior survival on dialysis and benefit most from a pre-emptive kidney transplantation. A nationwide study conducted in the Netherlands included 2,796 patients with type 1 diabetes who started renal replacement therapy between 1986 and 2016 and compared long-term survival in those who received a SPK with those who received a living- or deceased-donor kidney transplant alone. SPK transplant was associated with improved patient survival, especially in recipients with a long-term functioning pancreatic graft, and resulted in an almost twofold lower 10-year mortality rate. This finding suggests that, where appropriate, SPK rather than kidney transplant alone should be the preferred option.

Read more at: https://care.diabetesjournals.org/content/early/2019/12/03/dc19-1580

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Aetiology and management of acute interstitial nephritis

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Acute interstitial nephritis (AIN) may be a contributory factor in up to 35% of cases of acute kidney injury. The typical histological lesion is infiltration of the interstitial renal tissue by inflammatory cells. AIN can complicate a variety of diseases, including autoimmune conditions (Sjögren’s syndrome, inflammatory bowel diseases, primary biliary cholangitis and sarcoidosis), infections, oxalosis, mushroom intoxication and exposure to certain drugs (antibiotics, non-steroidal anti-inflammatory drugs and proton pump inhibitors). AIN often progresses to interstitial fibrosis necessitating prompt identification and appropriate treatment. Steroids are the mainstay of therapy in AIN associated with autoimmune diseases, while their role in drug-induced AIN is less clear cut. Read more about the aetiology and treatment of AIN in the latest NDT Digest article.

Read full article: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfz262/5715960

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Serum bicarbonate as a cardiovascular risk factor

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Cardiovascular disease (CVD) remains the leading cause of death in chronic kidney disease (CKD) patients. Metabolic acidosis is a risk factor for CVD and increases overall mortality risk in CKD patients, but also in the general population. An editorial by D. E. Wesson in Nephrology Dialysis Transplantation (NDT) explores available evidence on the mechanisms through which acidosis increases CVD risk and explains possible interventions to correct acid-base balance and thus reduce the risk.

Read full article at: https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfz297/5719358

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